31B-004 (20) SECTION SENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. ❑Agent
X
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
3. Service Type
❑Certified Mail ❑ Express Mail
(/ ❑Registered ❑ Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Numbe 7012 3050 0000 8965 7867
(Transfer from
i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540;
CERTIFIED MAIL
0
RETURN IN s DAYS 7012 3058 0000 8965 7867
DEPARTMENT OF BUILDING INSPECTIONS 0
212 Main St. Rm. 100 • Municipal Building
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Northampton, MA 01080:3 99=
Janet Gross
38 Round Hill Road L5
Northampton, MA 01060
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